Constipation

Basics

Description

  • Most common digestive complaint
  • May be due to organic cause or may be idiopathic/functional
  • Symptoms include hard stools, infrequent bowel movements, bloating, abdominal pain
  • More common in women, age >60, limited physical activity
  • Revised Rome Criteria for the diagnosis of constipation requires 2 or more of the following for at least 3 mo:
    • Straining >25% of the time
    • Lumpy or hard stools >25% of the time
    • Incomplete evacuation >25% of the time
    • Sensation of anorectal blockage >25% of the time
    • 2 or fewer bowel movements per wk
    • Use of manual maneuvers to facilitate bowel movements
    • AND insufficient criteria for irritable bowel syndrome
    • AND loose stools rarely present without laxative use

Pediatric Considerations

  • Often present with fecal incontinence despite toilet training due to fecal impaction
  • May present with urinary symptoms such as incontinence or UTIs
  • Most common cause of fecal retention and soiling in children is functional fecal retention:
    • Caused by fear associated with defecation
    • Associated with irritability, abdominal cramps, decreased appetite, early satiety

Etiology

  • Chronic idiopathic constipation:
    • Normal transit/functional constipation
    • Slow transit constipation
    • Defecation disorders
  • Organic causes of constipation:
    • Anorectal conditions:
      • Enterocele/rectocele
      • Prolapse
      • Descending perineum syndrome
      • Traumatic
      • Anismus
    • Intestinal conditions:
      • Carcinoma
      • Stricture
      • Hernia
      • Volvulus
      • Intestinal pseudo-obstruction
    • Metabolic and endocrine:
      • Diabetes
      • Uremia
      • Porphyria
      • Hypothyroidism
      • Hypokalemia (severe)
      • Hypomagnesium (severe)
      • Hypercalcemia
      • Pheochromocytoma
      • Panhypopituitarism
      • Pregnancy
      • Menopause
      • Celiac disease
    • Myopathy:
      • Systemic sclerosis
      • Amyloidosis
    • Neurologic:
      • Parkinson’s disease
      • Multiple sclerosis
      • Cerebrovascular accidents
      • Spinal cord lesions/injury
      • Chagas disease
      • Autonomic neuropathy
      • Myelodysplasia
      • Myotonic dystrophy
      • Botulism
    • Pharmacologic:
      • Analgesics
      • Anesthetics
      • Antacids
      • Anticholinergics
      • Anticonvulsants
      • Antidepressants
      • Antiemetics
      • Antihistamines
      • Antihypertensives
      • Antipsychotics
      • Calcium channel blockers
      • Diuretics
      • Ferrous compounds
      • Laxative abuse
      • Monoamine oxidase inhibitors
      • Opiates
      • Paralytic agents
      • Parasympatholytics
      • Phenothiazines
    • Psychological conditions:
      • Disordered eating
      • Depression
    • Other:
      • Dietary protein allergy
      • Immobility

Pediatric Considerations

  • Etiology similar to adults, but also consider:
    • Intestinal/anorectal conditions:
      • Cystic fibrosis
      • Hirschsprung’s disease
      • Neuronal intestinal dysplasia
      • Anorectal malformations
    • Neurologic conditions:
      • Spinal cord abnormalities
      • Tethered cord
      • Neurofibromatosis
    • Heavy metal toxicity
    • Sexual abuse

There's more to see -- the rest of this topic is available only to subscribers.

© 2000–2026 Unbound Medicine, Inc. All rights reserved
All content is protected by copyright and may not be used for AI model training or other unauthorized purposes.